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Do You Really Have Any Control Over Your Bipolar Treatment?

May 10, 2011
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One of the crazy things that will happen to you when you seek treatment for being crazy, is doctors will ask you what treatment you want. Usually your psychiatrist/doctor will give you two options: Would you like to try psych med A or psych med B? This provides the mirage of control over your mental illness and your mental illness treatment.

Patients Choosing Psych Meds has an Air of Hilarity to It

This choice, of course, is ridiculous.* How should you know which medication to pick? They’re the doctor, the fancy psychiatrist, aren’t they supposed to know?

Do you pick the one that’s your favorite colour or matches your hair?

What criterion could you possibly use to pick a psychotropic medication that would conceivably compare to an actual doctor? Most patients, bipolar or otherwise, don’t even know the chemical name of their psychotropic medication. And why should they? All the di’s, tri’s, methyl’s and dride’s don’t really come in handy on a day to day basis.

The Doctor Is Fighting Learned Helplessness

What the doctor is doing here, is using basic psychology similar to the type parents use on their children.

Your child won’t go to bed. You say to little Billy, “which pajamas would you like to wear, the Spiderman or the Superman ones?” The child then focuses on the fact they get to make a decision, they feel empowered and are less likely to refuse to go to bed. The adult, of course, has given the child a choice the parent doesn’t care about. Superman or Spiderman, the kid is still getting into bed.

This is what doctors are doing. They are giving the person with a mental illness a choice that doesn’t matter. Sure, it seems like it matters because they’re drugs, and your life is on the line, but either way, you’re agreeing to a treatment, and that is all the doctor cares about. (It is why you are there, after all.)

Psychiatrists are Trained to Prevent Learned Helplessness

Doctors have been trained to do this because of the concept of learned helplessness. Learned helplessness is seen in lots of areas of life, but the basic principle is: the person comes to believe they are helpless, whether or not they truly are. A common example of this would be a battered spouse. Because they have been repeatedly abused and controlled, they start to think they don’t have control over anything in their life, even when they do. (Abusing people programs them this way and is one of the reasons an abused person doesn’t leave an abusive relationship.)

[a person] has learned to behave helplessly, even when the opportunity is restored for it to help itself . . . Learned helplessness theory is the view that clinical depression and related mental illnesses may result from a perceived absence of control over the outcome of a situation.

Learned Helplessness is Dangerous in Mental Illness

And this is a very real concern for the mentally ill because not only are you controlled by your disease, but then you’re controlled by the drugs put on top of that. If you then add the layer whereby you doctor is in complete control over your care, the patient begins to feel helpless in increasing areas of their life. This is problematic, particularly for the crazy, because that kind of helplessness, leads to hopelessness, which leads to suicide. When you can’t control anything, there is just no reason to stick around.

Choice of Psychotropic Medication Treatment Feels like a Game Show

But choosing between psychotropic pill A and pill B is akin to choosing to be hit on the head by a baseball bat or a two-by-four. I’m pretty sure there is no good option there. But it gets worse. Choosing a psych med is really more like choosing the blunt object behind curtain A or the blunt object between curtain B. You don’t know the ramifications of the decision. You don’t even have a shaded outline of what to expect. It’s like choosing a car based on how far apart the headlights are. It’s ridiculous. It’s laughable.

Control of Mental Illness, Control Over Treatment

You can choose whether to get treatment or which pill to take, whatever that’s worth, but often these things feel surprisingly similar. Even a person who doesn’t exhibit learned helplessness can reasonably feel completely out of control.

And you can feel as empowered as you like, but the truth is, you really don’t have control. You didn’t have control over your brain when you got sick, you don’t have control over getting worse and you don’t have control over how your treatment goes, no matter the window dressing provided by the doctor.

Notes:

* Choice of medication is, in fact, critically important. And if you haven’t been treated for long, there are many objective ways to select a treatment. However, for cases of treatment-resistant bipolar or major depressive disorder, the choice becomes more and more random as the objectively correct choices have already been tried. ^ I’m not suggesting that you shouldn’t choose, or that choice isn’t important, I’m simply the frustration inherent in the choice.